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目的探讨多期动态增强MR扫描参数在鉴别肝脏良恶性病变中的临床价值。方法选取我院2015年2月至2016年12月收治的肝脏占位性病变患者106例,对106例患者各病灶进行动态增强MR扫描,测量患者病灶最大上升斜率(MSI)、信号增强率(SER)、正性增强积分(PEI)、最大下降斜率(MSD)和峰值(PV)情况,比较不同病灶动态增强MR扫描参数,并进行统计学分析。结果肝细胞癌、转移瘤、肝内胆管细胞癌、肝脓肿、血管瘤、局灶性结节增生的MSI、SER、PEI、MSD及PV各值差异有明显统计学意义(P0.05);血管瘤MSI、PEI、MSD、PV值明显高于肝细胞癌、转移瘤、肝内胆管细胞癌、肝脓肿(P0.05);局灶性结节增生在各类肝脏占位性病变中SER值明显高于转移瘤、肝脓肿、血管瘤(P0.05);86.48%肝细胞癌其曲线类型主要分布于Ⅰ型与Ⅱ型,63.63%转移瘤及55.55%的肝内胆管细胞癌其曲线类型主要分布于Ⅱ型,77.77%的肝脓肿、66.66%的血管瘤其曲线类型主要分布于Ⅲ型,80.00%的局灶性结节增生其曲线类型主要分布于Ⅱ型。结论肝脏良恶性病变动态增强曲线类型、量化参数存在差异性,结合两者可提高疾病鉴别诊断能力。 相似文献
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刘伟 《中西医结合肝病杂志》2007,17(3):167-168
目的:探讨彩色多谱勒能量图(CDE)对肝肿瘤诊断的价值。方法:对40例肝癌和30例血管瘤及10例肝腺瘤样增生结节患者进行了CDE、彩色多谱勒血流显像技术(CDFI)检查,并与数字减影血管造影(DSA)进行对照。结果:40例肝癌患者其瘤体内3种方法血流检出率分别为:CDFI45%,CDE85%,DSA80%;30例肝血管瘤患者其瘤体内血流检出率分别为:CDFI30%,CDE80%,DSA70%;10例肝腺瘤样增生结节患者其增生结节内血流检出率为:CDE40%,CDFI和DSA无1例显示动脉供血。肝癌动脉肿瘤输入血管检出率为85%,门静脉肿瘤输入血管检出率为45%;肝血管瘤、肝腺瘤样增生结节门静脉肿瘤输入血管检出率为60%,无动脉肿瘤输入血管,CDE较CDFI在瘤体内血流检出上更灵敏。结论:动脉肿瘤输入血管检出率对鉴别肝癌与肝血管瘤、肝腺瘤样增生结节有一定的意义。彩色多谱勒能量图对肝肿瘤的诊断有一定的临床意义。 相似文献
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目的探讨磁共振弥散加权成像(MR DWI)结合增强扫描对肝脏占位性病变的诊断价值。方法回顾性研究56例肝脏占位性病变的MR DWI及增强表现,所有病变均经临床追踪或手术病理证实,包括肝细胞癌11例、胆管细胞癌8例,转移瘤9例、海绵状血管瘤13例、肝囊肿15例。结果肝细胞肝癌典型强化方式为快进快出,胆管细胞癌多为门脉期及延迟期轻度强化,转移瘤多呈环形强化,海绵状血管瘤多呈逐渐强化,少数较小病灶为动脉期强化,并持续至延迟期,肝囊肿无明显强化。在MR DWI上肝细胞肝癌、胆管细胞癌、转移瘤多为稍高信号,海绵状血管瘤为明显高信号,肝囊肿呈低信号。肝细胞肝癌、胆管细胞癌、转移瘤弥散系数(ADC)值差异无统计学意义(P>0.05),但明显低于血管瘤与肝囊肿囊内ADC值(P<0.05),肝囊肿ADC值明显高于其他各组(P<0.05)。结论 MRDWI在肝脏良恶性病变鉴别诊断中具有重要作用,结合增强扫描可提高诊断准确率。 相似文献
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目的:探讨肝脏肿瘤囊实性病变的影像学特点,为其诊断及鉴别诊断提供依据。方法分析49例肝脏肿瘤(原发性肝细胞癌26例,肝内胆管癌3例,肝脏恶性纤维组织细胞瘤2例,炎性肌纤维母细胞瘤2例,肝脏囊腺瘤1例,肝脏转移瘤15例)患者的CT和MR影像学表现,总结其特点。结果肝细胞癌囊变区CT主要表现为形态不规则水样低密度,MR主要表现不规则长T1长T2混杂信号;CT及MR增强检查实性区具有“快进快出”强化特点。肝内胆管细胞癌CT表现为肿瘤中心部分不规则低密度囊变区,肿瘤周围可见迂曲扩张的胆管,MR表现为囊变区呈不规则长T1长T2混杂信号;CT及MR增强检查实性区均可见延时强化。肝脏恶性纤维组织细胞瘤CT表现为花环状或中心囊变。炎性肌纤维母细胞瘤CT表现为分隔状囊变,囊壁及分隔厚薄不均。肝脏胆管囊腺瘤CT表现为分隔状囊实性肿块,其内见壁结节。肝转移瘤表现为肝内多发病灶,具有边缘环形强化特点。结论 CT和MR为诊断肝脏肿瘤囊实性病变的较好方法。 相似文献
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3.0T磁共振弥散加权成像在肝脏局灶性病变中的诊断价值初探 总被引:2,自引:0,他引:2
目的初步探讨3.0T磁共振弥散加权成像(DWI)对肝脏局灶性病变的鉴别诊断价值。方法采用GE 3.0T Signal EXCITE超导型磁共振扫描系统对65例共68个病灶患者行DWI,并分析病灶信号特征。肝囊肿13个病灶,肝血管瘤12个病灶,炎性假瘤4个病灶,局灶性结节性增生(FNH)5个病灶;肝细胞癌13个病灶,转移瘤21个病灶。应用弥散敏感系数b值0、500、1000 s/mm2的图像拟合出ADC图并测量ADC值。结果肝囊肿、血管瘤、炎性假瘤、FNH、肝细胞癌、转移瘤平均ADC值(×10-3mm2/s)分别为3.34±0.45、2.07±0.35、1.59±0.16、1.50±0.18、1.25±0.31、1.04±0.20;肝囊肿、血管瘤与其它病灶平均ADC之间差异均有统计学意义(P〈0.05)。随着b值的增加,肝囊肿信号衰减最明显,肝细胞癌、转移瘤信号衰减不明显。结论 3.0T磁共振弥散加权成像及其定量ADC值对肝脏占位病变的鉴别诊断具有重要的临床价值。 相似文献
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原发性肝未分化肉瘤的病理特征(附2例报告) 总被引:1,自引:0,他引:1
目的探讨原发性肝未分化肉瘤的病理特征。方法对2例原发性肝未分化肉瘤患者的的病理检查资料作分析。结果肿瘤呈胚胎性间叶性分化,异型性明显并可出现多核瘤巨细胞,核分裂多见,间质为丰富的黏液样基质;肿瘤边缘可见包绕的肝细胞和扩张的胆管,在瘤细胞质内或细胞外基质中可见PAS阳性的嗜酸性球形小体;免疫组化检查瘤细胞Vim、desmin、SMA均可阳性。结论原发性肝未分化肉瘤可能来自原始多潜能干细胞,其组织学呈现为肿瘤形态多样性和分化方向不确定性。 相似文献
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《心肺血管病杂志》2017,(12)
目的:探讨肺转移性肿瘤的临床病理学特点、诊断及鉴别诊断。方法:回顾性分析2010年至2016年间,113例肺转移性肿瘤患者的临床资料,观察病理形态学特点,En Vision法进行免疫组织化学检测。结果:113例中男性48例(42.5%),女性65例(57.5%),年龄9~77岁,平均年龄55岁。胸部CT示,肺内多发结节61例(54%)、单发性结节52例(46%)。原发瘤为乳腺癌31例(27.4%),结直肠癌23例(20.4%),透明细胞性肾细胞癌15例(13.3%),宫颈鳞癌13例(11.5%),卵巢高级别浆液性癌9例(8%),甲状腺癌7例(6.2%),其余15例为尿路上皮癌、胸腺癌,骨肉瘤、恶性黑色素瘤、平滑肌瘤、平滑肌肉瘤、腺泡状软组织肉瘤。肺转移性肿瘤多表现原发肿瘤的病理形态学特征,免疫表型与原发肿瘤一致。结论:肺是其他器官肿瘤较常见的转移部位,多表现原发肿瘤的形态学特征,有时易误诊为原发肺肿瘤。结合临床病史、病理学形态及免疫表型特征有助于肺原发与转移性肿瘤的诊断及鉴别诊断。 相似文献
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常见肝内胆管恶性肿瘤有肝内胆管癌(ICC)、细胆管细胞癌(CLC)及混合细胞型肝癌(CHC)中的胆管癌成分。ICC是肝脏第二常见恶性肿瘤,根据我院手术切除的3.3万余例肝脏恶性肿瘤的病理资料统计,肝细胞癌(HCC)和ICC分别占85.6%和7.7%,ICC的发病呈逐年上升趋势,具有易转移复发的生物学特性;CLC少见,因起源于肝脏双向分化的前体细胞而具有侵袭性强的特点;CHC的病理检出率有增多趋势,预后较HCC和ICC更差。准确的病理分型对于临床诊治和预后评估具有实际意义。 相似文献
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Over the last decade, major advances in computed tomography and magnetic resonance technology have occurred. These advances enable accurate, noninvasive detection and characterization of many hepatic neoplasms. This article illustrates the role of imaging in the evaluation of hepatic neoplasms and reviews the typical imaging features of both benign and malignant hepatic tumors. Benign tumors discussed include hemangiomas, focal nodular hyperplasia, hepatocellular adenoma, and simple cysts, as well as cysts associated with polycystic liver disease. Malignant neoplasms reviewed include metastases and conventional hepatocellular carcinoma as well as less common tumors such as fibrolamellar hepatocellular carcinoma, intrahepatic cholangiocarcinoma, angiosarcoma, and epithelioid hemangioendothelioma. 相似文献
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目的 比较使用3.0 T 磁共振-肝脏容积快速采集(MR-LAVA)序列多期动态增强扫描定性诊断肝硬化结节病变的价值。方法 2015年1月~2017年8月我院诊治的乙型肝炎肝硬化患者,行3.0 T MR-LAVA序列多期动态增强扫描和CT增强检查。比较两种检查方法检出病灶情况及其表现特征。结果 MR-LAVA序列扫描检出病灶80例,而增强CT扫描检出病灶73例(91.3%);MR-LAVA序列检查定性诊断为局灶性结节性增生40例,血管瘤13例,原发性肝癌10例(均表现为富血供病变),转移瘤17例,而CT检查定性诊断为局灶性结节增生34例,血管瘤12例,肝细胞癌9例和转移瘤18例。结论 3.0 T MR-LAVA序列多期动态增强扫描能提高对肝硬化结节病变的定性诊断,值得临床进一步验证。 相似文献
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目的分析早期肝癌的各期增强图像的特点,以期提高临床早期肝癌的检出率。方法以本院手术病理或临床随访证实的直径3cm以下的115例肝占位患者为研究对象,回顾性分析早期肝癌患者64排螺旋CT多期增强扫描各期图像的特点,其中肝细胞癌42例,肝转移癌37例,肝血管瘤36例。结果三组病例在性别构成、年龄分布方面均无显著差异(P均0.05)。肝细胞癌在动脉期多表现为高密度强化,比例显著高于肝转移癌(P0.001);而在门静脉期和平衡期多表现为低密度无强化,比例亦显著高于肝转移癌和肝血管瘤(P0.001)。结论 64排螺旋CT多期增强扫描是诊断早期肝癌行之有效的方法。 相似文献
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Association of focal nodular hyperplasia and hepatic hemangioma 总被引:1,自引:0,他引:1
The association between hepatic hemangioma and focal nodular hyperplasia has been occasionally reported. To evaluate the reality of this association, the prevalence of hemangioma was studied in 26 patients with focal nodular hyperplasia by comparison with 27 patients with hepatocellular adenoma. All of these patients underwent surgery, which provided the histologic confirmation of the type of tumor. The presence of hemangioma was assessed by preoperative ultrasonography, dynamic computed tomography, and pathological examination of resected liver specimens. No hemangioma was found in patients with hepatocellular adenoma, but 6 of the 26 patients with focal nodular hyperplasia (23%) had one or two associated hemangiomas that varied in size from 1.5 to 4 cm. All 6 patients having focal nodular hyperplasia and hemangioma were women who had previously used oral contraceptives. None of the patients who had not used oral contraceptives had this association. Moreover, oral contraceptives were taken for a significantly longer period by the women with focal nodular hyperplasia and hemangioma than by those without this association. It is concluded that (a) the association of hemangioma with focal nodular hyperplasia is frequent (23%) and not fortuitous, and (b) prolonged administration of oral contraceptives may facilitate the recognition of this association, possibly by affecting the growth of these tumors. 相似文献
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Coelho JC Claus CM Machuca TN Sobottka WH Gonçalves CG 《Arquivos de gastroenterologia》2004,41(4):229-233
BACKGROUND: Liver resection constitutes the main treatment of most liver primary neoplasms and selected cases of metastatic tumors. However, this procedure is associated with significant morbidity and mortality rates. AIM: To analyze our experience with liver resections over a period of 10 years to determine the morbidity, mortality and risk factors of hepatectomy. PATIENTS AND METHODS: Retrospective review of medical records of patients who underwent liver resection from January 1994 to March 2003. RESULTS: Eighty-three (41 women and 42 men) patients underwent liver resection during the study period, with a mean age of 52.7 years (range 13-82 years). Metastatic colorectal carcinoma and hepatocellular carcinoma were the main indications for hepatic resection, with 36 and 19 patients, respectively. Extended and major resections were performed in 20.4% and 40.9% of the patients, respectively. Blood transfusion was needed in 38.5% of the operations. Overall morbidity was 44.5%. Life-threatening complications occurred in 22.8% of cases and the most common were pneumonia, hepatic failure, intraabdominal collection and intraabdominal bleeding. Among minor complications (30%), the most common were biliary leakage and pleural effusion. Size of the tumor and blood transfusion were associated with major complications (P = 0.0185 and P = 0.0141, respectively). Operative mortality was 8.4% and risk factors related to mortality were increased age and use of vascular exclusion (P = 0.0395 and P = 0.0404, respectively). Median hospital stay was 6.7 days. CONCLUSION: Liver resections can be performed with low mortality and acceptable morbidity rates. Blood transfusion may be reduced by employing meticulous technique and, whenever indicated, vascular exclusion. 相似文献
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Hiroki Mori Toru Ikegami Satoru Imura Mitsuo Shimada Yuji Morine Hirofumi Kanemura Yusuke Arakawa Mami Kanamoto Jun Hanaoka Koji Sugimoto Takuya Tokunaga 《Hepatology research》2008,38(5):529-533
A sclerosed hemangioma of the liver is an extremely rare type of benign hepatic tumor. A 77-year-old female was referred to Tokushima University Hospital with fever, abnormal liver function tests and a large liver mass. The tumor, 10 x 5 cm in size and located in segment 5-6 of the liver, was depicted as a low density tumor with enhancement by computed tomography (CT). Magnetic resonance imaging (MRI) showed it to be a tumor with a low signal on T1-weighted and a high signal on T2-weighted images. The patient was negative for hepatitis B surface antigen and hepatitis C antibody. She underwent a right hepatectomy for possible malignant liver tumors, including intrahepatic cholangiocarcinoma or fibrolamellar hepatocellular carcinoma. The following histological examination of the surgical specimen revealed the tumor to be a hepatic sclerosed hemangioma with characteristic dense collagenous tissues. We report here on the case of this unusual tumor and review the relevant literature. 相似文献
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Y Taniguchi 《Nihon Shokakibyo Gakkai zasshi》1992,89(10):2568-2576
Plain CT and subsequent dynamic (or enhanced) CT demonstrated liver tumors in 43 patients: hepatocellular carcinoma in 24 patients, metastatic liver tumors in 15 patients and hemangioma of the liver in 4 patients. Delayed CT was furthermore performed 4 hours later to investigate its significance in the diagnosis of hepatic metastases by primarily comparing it with plain CT. The difference in CT numbers between the lesion and the normal hepatic parenchyma at delayed-type scanning 31.48 +/- 7.41 HU in metastatic liver tumors, which was significantly higher than 17.37 +/- 11.32 HU in hepatocellular carcinoma (p < 0.001). TDI after delayed CT was -0.43 +/- 0.13 in metastatic liver tumors and -0.26 +/- 0.15 in hepatocellular carcinoma, between which a significant difference was noted (p < 0.01). Delayed CT presented similar images to those obtained from plain CT in 14 of the 24 patients with hepatocellular carcinoma (58.3%) and a less clear tumor boundary in the remaining 10 patients (41.7%). On the other hand, the tumor boundary became clearer in 12 of the 15 patients with metastatic liver tumors (80.0%) at delayed-type scanning, than after plain CT, although the images remained almost unchanged in the remaining 3 patients (20.0%). The findings obtained from delayed CT in hemangioma of the liver were little different from those obtained from plain CT. This study suggested that delayed CT might better detect metastatic liver tumors than could plain CT. Delayed CT is recommended when metastases from other organs to the liver are suspected, and particularly when such metastatic liver tumors are small in size and multiple. 相似文献